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We put my dad in assisted living and he has really thrived with the socialization and participates in some of the activities. We have a buy-up plan for med management, shower assist, etc. I'm afraid that memory care would not be enough stimulation for him although I believe in the next year or so, we may move him. He is forgetting more and more lately. When I was visiting different facilities, several of the memory care places asked me why I was considering those. They all asked me the same thing: does he wander? does he get lost? Memory care is a lockup. He is definitely not ready for that. And they agreed. But do consider a buy-up plan for assisted living if the base plan isn't enough care.
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disgustedtoo Feb 2020
As noted to another post about wandering - they don't until they do, and there are NO warning signs beforehand! There's also no one "guarding" the door, asking for hall passes. AL and IL are free to come and go as they please. Sometimes the receptionist isn't even at the desk, attending to something. Even if they were there 100% of the time, how would they identify this person as potential wanderer? With some staff turnover, they wouldn't even know all the residents!

I KNOW my mother would have found the entrance and walked out, although she never wandered from her own place (YB disagreed with MC.) Within 9 mo of moving in, she was asking to get dropped off at her mother's (gone 40+ years) and was going to walk to her place, my place, her previous home, etc. She may have been asking staff about it prior to that (never asked me to bring her back to her condo, she saved that for YB thankfully!) but no way to know.

By the time they realize someone has wandered, it might be too late...

It should be based more on the current capability and how good the short term memory is - mom would never have been able to get from A to B without help. One has to anticipate AND understand progression happens at different rates for different people (just like any baby's progression from rolling over to crawling to walking, etc - it varies a lot and there are no real warnings!)
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It seems that a lot of folks fall between AL and MC.

My LO fell between the two and continues to do so after a year and 9 months of residential care.

It was VERY TOUGH for me to accept the recommendation of the center that she needed the locked MC placement, but they proved to be absolutely right.

There is PLENTY TO DO in her MC unit, and higher functioning residents can go to religious services, concerts, the beauty salon on site, and MANY other activities with the higher functioning AL folks.

Socialization and boredom are NEVER concerns in her residence. Look for good programs before you choose......
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disgustedtoo Feb 2020
BINGO! Mom's place has activities, even field trips for those capable and willing, hairdresser, sometimes join in special activities or events with the AL/IL sections, etc.

My suggestion was to visit the MC area again, preferably at meal time. You would see a much better representation of all the residents. At other times the only ones you might observe in the "common" area might be those who are more challenged, physically and/or mentally, who require more care. Others may not be present, so you don't get the full picture.

Mom's place (and her residence) just started year 4. Those who moved in at the same time and similar level are gone. Others have moved in/out. There is always a mix of capability present in her place, and various activities geared to the resident's interest/ability.

Always go several times at different times of the day to get a better idea what ANY facility offers.
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Both my MIL and FIL have dementia early stages pf Alzheimer's. They are in assisted living presently, started off in independent living one year ago. Just the other day at their one year anniversary review we asked how are they on reference to being moved to memory care. What do they look for? At our facility besides the obvious cognitive decline they look for "wandering ". When this happens in assisted living they will make recommendations to the family to be moved to memory care.
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disgustedtoo Feb 2020
I find that is a rather poor criteria. Close the barn door after the horse has bolted? Not sure about other AL facilities, but there is no one to "watch" the entrance to see if AL residents at mom's facility are "escaping" or "wandering" as it is an open door for IL/AL residents. Not like they have obvious markers on them saying beware this one may try to escape - generally there is no "warning" before the wandering starts...
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I faced this exact same dilemma a few years ago. At the time, I couldn't imagine my mother being happy in the memory care section of the assisted living facility. It was going to be a huge change for her to even move into assisted living from her home so we opted to hold off on memory care until her dementia was further along. At the time she was not a wanderer, sundowning was minimal and she could easily carry on a conversation. At first she enjoyed the many activities but after about a year and a half, she was much more confused and quite frankly wasn't interested in crafts, movies or happy hour parties. Eventually, the staff said she tried to wander on "field trips", she rarely talked with the other residents and she needed much more prompting for daily life activities. She seemed ready for memory care, so we moved her to that section and even that was easier because by then and we just told her she was going to a new room that was better for her. Within a day or two she was settled in and in all honesty felt safer with more care. I was glad she had enjoyed that time in assisted living. It probably took more work to move her twice but she just wasn't ready. If your mother is not at risk of trying to leave or feel confused by the freedom of assisted living, I would encourage you to place her there and then move her to memory care when needed.
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It the facility has a memory care unit that has so little stimulation, I'm not sure that their assisted living will be all that great. Because they should be providing stimulation in their memory care unit as well! Furthermore, now the aim is to allow for residents to 'age in place,' even in these long-term care communities. While it's true that your mom might decline soon, if she is in a good place that stresses engagement with residents she may well thrive. And let's be honest, most people living in assisted living (rather than independent senior homes) probably have some degree of cognitive loss going on.

Are you sure there is no better place available, one that is more person-centered? For-profit long-term care communities are notorious for finding some basis on which to raise a resident's rate of payment: "She needs more care now." "His memory is failing." I hope you can find a better place, one that isn't waiting for your mom to need more care, but to give her the kind of care that helps her thrive rather than decline. Best of luck.
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disgustedtoo Feb 2020
"...most people living in assisted living (rather than independent senior homes) probably have some degree of cognitive loss going on."

Not in the facility our mother is in! It is IL/AL/MC and to get to MC one has to enter where everyone else does - I meet and chat with various residents from all levels. There was one AL gentleman who is actually older than my mother, no walker, or other assistance, sharp as a tack! Most I have met are just fine mentally. Age and physical ability are the more important deciding factors in choosing IL vs AL. While someone in the early stages of dementia might do fine in AL, initially, it can be hard to make the move when it is needed. My YB and I didn't agree on where mom should go, but staff said NO to AL after assessment and meeting her. Outwardly she could seem fine, and could function "fairly" well at that point, but it doesn't improve...
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Does the memory care offer anything for residents that are more mentally aware. My moms place has something called terrace Club. It’s a program she was part of when she was in the ALF. They meet twice a day in their own beautiful area and play games. Do trips etc. they still will come and get some of the better residents from memory care and bring them up to terrace club. It’s a hard decision because if she gets used to AlF she won’t want to move. My mom has the worst time transitioning. Her problem was mostly being a fall risk

good luck. ❤️
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I am going through the exact same thing. Mom is only 77 and is declining with her dementia . She is high functioning with everything except for her memory . They put her in the memory care section where she does not belong and is getting worse . I am afraid if we put her in assisted living she will flee .
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disgustedtoo Feb 2020
Is there proof that your mother is 'getting worse' because she is in MC, or is she just getting worse, which is normal for dementia? Does the place work on keeping the residents active and engaged? Makes a difference,

In mom's MC, several who moved in about the same time and about the same level are already gone (they progressed beyond most capability and either had to move to NH or passed away.) Others who have come later, some younger than ME, have progressed and/or moved on more than our mother. Our mother is declining, but slowly. She just started year 4. The first year she had a step down in memory at about 9 months (started asking about HER mother and forgetting her condo, but remembering a previous home from over 25 yrs ago.) She was still walking unassisted and doing most ADLs and continued to do so. It took 2 years before she asked for a rollator, but still mostly cared for herself. About 4-5 months ago she developed fear of standing/walking, so now she's in a wheelchair.

Memories are still slowly regressing, so she is living in about 40+ years ago, but given the progressions seen in others vs hers, MC isn't the cause.... She still know who I am and while communication is hard due to nearly non-existent hearing and the dementia, she still gets along great with staff! She's 96 now.
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The dividing line really shouldn't be so very stark as all that. Why is there so little stimulation provided in the memory care unit? It's a bit of a chicken-and-egg, of course - no activities because the residents aren't up to it, versus the residents are vegetating because there is so little mental stimulus - but that's the point I'd question with the staff. There shouldn't be such an impermeable boundary.

For example: could your mother (with other more able MCU residents) join in appropriate activities sessions in the ALF? Or the other way about - what would stop them bringing ALF residents to pet therapy in the MCU, as another example?

If this facility prides itself on continuing care, there should *be* a continuum. Challenge them on it.
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disgustedtoo Feb 2020
I also questioned the MC "view." Could it have been the wrong time of day or are ALL the residents like that. Mom's place is and has been a mix of capabilities and levels of progression. Some residents who are more "capable" could be in their rooms or doing other activities elsewhere. That would leave only those who are not mobile or need more supervision.

As for "... join in appropriate activities sessions in the ALF..." I'm glad you wrote this! When mom first moved in, she was the first and only resident (several were to move in at the same time, newly opened MC, but were delayed), so there were many times I would find her upstairs with an aide and AL residents. They also often bring those who are capable to various activities (with staff to watch over them) to some of the AL functions/activities.
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ASSISTED LIVING BY ALL MEANS.
Unless she is a flight risk.
My father was in assisted living until he recently passed, and there are statistics that when they are placed in memory care, they decline much faster.

Most assisted Living facilities are so crowded now, that they put ankle bracelets on their ankles so if they are not locked in, the door beeps loud if they leave.

I know all my clients that had Dementia and or Alzheimer's or many other issues, the children would not put them in memory care. One son was a fireman, and he said he could tell the difference just by going to the different floors.
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disgustedtoo Feb 2020
"Unless she is a flight risk."
Problem with dementia is you don't know if/when this might happen. They haven't been a risk until they were...

My YB had arguments for AL vs MC, which were silly actually. "Oh, she won't want to be in with a bunch of old farts." Not everyone in AL is an old fart and not everyone in MC is either - dementia knows no age. There have been several residents in mom's MC who weren't even early retirement age!!! AL vs MC with walkers, canes, rollators, wheelchairs is about even. When I mentioned that there was no control at the door to AL, she could walk out at any time, he responded with 'She doesn't do that now.' No, HOWEVER that was her own place and she was self-isolating. Here she won't know where she's at and can walk out the door looking for home. Staff who were there said no, MC.

Although she had never wandered prior to the move (that we are aware of anyway), based on what I saw/heard myself, she WOULD have left the facility... looking for her mother's place, my place, her home previous to the condo she was in last, etc. She would often ask where her room was, easiest one to find right at the corner of the common area. She WOULD have been a serious flight risk if we let her move into AL!
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In my mom's case, when in AL, they assisted with everything. All she really had to remember was to go to the dining room for meals - and, believe me, they do! If someone didn't go to meals, an aide would go to their room and check on them. Also, other residents help. Someone would say, "Where's my room?" and others would say, " go that way". They get A LOT of help in AL. Nurse brings meds, aides bathe them on a schedule, someone does laundry, etc.
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AllieB4 Feb 2020
Yes I agree. Residents love to help each other out. They are like mother hens. My mom at 94 has been in ALF since October. They have a welcoming committee, a buddy system initially. My mom currently does not need any assistance, but there are 6 levels of care in AL! So there is a lot of help she can get if and when she needs it. My mom feels enough of a loss of privacy in AL and enough structure (compared to living alone), that she would feel imprisoned in MC.
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Or she may thrive with proper nutrition, social stimulation and proper med management.

I would place her in AL and see how she does. MC is not for someone that can function at all from what I have seen.

My dad improved tremendously by getting the above.
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lealonnie1 Feb 2020
My mother is in MC and can function quite well. Everyone is at different levels of dementia and need in a MC environment, at all stages of the disease. Some are in MC due to mobility issues AND dementia combined; when they become too much for AL, they can be transferred to MC.
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There was a woman who was in the MC unit at the facility we had our mom in. You wondered why in the world she was even there! She seemed normal! She was in the very beginning stages of dementia but you'd never know it. She loved being there and helped out with the other residents. We loved having her there since she also made my mother happy because she was someone my mother could sort of talk with, when my mother was having a good day. So many of the other residents couldn't carry on a conversation with anyone, but this woman could. So depending on how your mom is, she may do better in MC, even if she is between the lines at this point. It could give her some purpose if she thinks she is "helping" the other residents.

On the other hand, it could be depressing to her, so you may be the better one to judge this depending on her personality.
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disgustedtoo Feb 2020
Exactly - there should be a mix of abilities, unless those who are there have been there years, with no new residents. My suggestion was to visit the MC again at different times, preferably at meal time, as you would get a better "feel" for all the residents. It could be that during the visit it was only those who require more care and/or are not mobile and need to be under more supervision, while others are elsewhere. Our mother's place has always had a mix. Several progressed beyond ability to interface, but other newer residents came and went over time, so there is always a mix.

The one I enjoyed was 99 when she moved in and was much more "with it" than my mother!! She loved jigsaw puzzles, which I like too, so we'd work on them together, getting mom to participate (which was surprising to me, she was never one to do this!) I gave her one for her 100th birthday! She almost made it to 101, but a serious fall hastened her demise. I miss her a lot!
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My mother was also right on the line between both types of units. We weren’t sure what to do. Facility thought she might not engage with people in AL and because there is less staff, she might just stay in room. We also did not want to move her to MC if she declined. We put her in MC and for her, it was awful. She was too high functioning for MC and she had no one to interact with. When we would take her back there, she would get off the elevator and basically run to her room. I still feel bad about it. We moved her to a different facility and she is much happier. I would put your mom in the AL unit and not worry too much about moving her if you need to later.
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Hello,

You may request from her Physicians to get her assigned to a Nurse Case Manager, these Case Managers usually have local resources at their fingertips. Be prepared to answer alot of questions about finances, etc. to also help determine what type of facility for her short- and long- term care.

Side Note: Regarding mental stimulation, also ask about Adult Day Care Centers as an outing.

Determine if she may also be eligible for Dual Health Coverage, meaning Medicare and State Medicaid, as per finances/liquid assets/etc... If you believe she qualifies for Government assistance besides Medicare, go to the local Social Security office and get a determination decision. Bring financial paperwork, POA to this meeting.

What's medically necessary for her short- and long- term care are the types of questions to start asking her Physicians.

Once, it gets narrowed down to a facility, please do what you can to learn if they have any complaints of abuse or neglect of Residents.

During the process, I strongly recommend you keep a special notebook to take down names, numbers, dates/times, instructions you will be given ....

Maybe see if there are any local CareGiver support groups for Dementia that you could go to? Sometimes, that could give you some golden nuggets from others in your circumstance that, either is or, has experienced on a personal level.

I hope this helps some, and I certainly hope all the best during the transition.

Kind regards,
Delene
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Defintely place her in the Assisted Living situation. If this is a good facility, such as the one my bro is in, they will let you know when there is progression that needs more care for her own safety along with the locked unit and better staffing. Do know that even in Memory Care people often adjust and socialize with one another quite well. She will need to go up in care, that is need more attention on level of care in Assisted Living, but where my bro is, people can maintain Assisted Living quite well with a bit of help for a long time. The costs will be so much more in Memory care, so that can be a factor as well. I see people at my brother's assisted living, and the assisted living facility itself struggle with just exactly "when" is the right time. But they will help to guide you. I am so thankful to the Assisted Living where my brother is. The people are absolutely MARVELOUS and I cannot say enough good about them.
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My step mother and her husband are in AL, when he dies she will be moved to MC. Right now he is able to keep track of her. I would start out in AL and go from there, the facility will guide you.
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My mother started out in Assisted Living & had to move to the Memory Care annex after 5 years. It's true that the MC is a bit less stimulating and the residents aren't as sharp as our mothers may be, so that's the dilemma. If it were me, I'd place my mother in the Assisted Living section UNLESS she has serious memory issues or you feel that she'd be unsafe using a microwave, or unable to function properly with the independence that's offered in such an environment. Only you can answer that question. My feeling is to put off Memory Care as long as possible, because she'll wind up there until the end of her life, more than likely. So what's the rush? My mother always says she wants to go back to the Assisted Living section, but last night, for instance, she called me at 8:15 pm asking why I hadn't called her. I did call her, 2 hours prior, and we'd had a 10 minute phone conversation. She'd completely forgotten it. Plus, she was insisting it was Tuesday even though she has an Alzheimer's clock in her room displaying the fact it was Saturday.

Wishing you the best of luck.
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disgustedtoo Feb 2020
If she were truly in the early stages, perhaps, but the staff said she is on the cusp. Moving is sometimes hard on dementia residents.

My concern would be more to ask about the other residents. Are they only seeing those who are visible at the time of visit, those who require more care or are not mobile, while the more "with it" residents are elsewhere?

Our mother was the first to move into the newly opened MC (entire IL/AL/MC was rebuilt) section. The other residents vary in capability and progression. Generally in the 3+ years she has been there, the mix has been varied between those who are more capable vs those who need help (or move on, either to another facility or pass.)

ANY MC facility should have activities and socialization to keep the residents active. I would either find another MC facility, or find out if they are only seeing those residents who are less capable (visiting at different times might be more revealing, esp at mealtimes.)
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